结外鼻型NK/T细胞淋巴瘤首发症状与确诊时间的关系及其确诊时间的影响因素研究

Analysis of Association between Initial Symptoms and Time Needed for Diagnosis in Extranodal NK/T-cell Lymphoma,Nasal Type and Effect Factors of Time Needed for Diagnosis

背景早期和晚期结外鼻型NK/T细胞淋巴瘤(ENKTCL)患者的预后有明显的差异,然而在临床实践中,ENKTCL常被误诊为其他疾病。之前部分研究认为ENKTCL的误诊可能与其首发症状的非特异性有关。目的分析ENKTCL首发症状与确诊时间的关系,探究影响ENKTCL确诊时间的因素,为ENKTCL的早期诊断提供参考。方法回顾性选取2009—2012年四川大学华西医院收治的符合纳入标准的ENKTCL患者的临床资料,分析患者首发症状与确诊时间的关系以及确诊时间的影响因素。结果最终纳入ENKTCL患者177例,年龄42(22)岁,男性居多(71.2%),常见的首发症状为鼻塞(54.8%),其次为鼻溢(21.5%)、发热(18.1%)、口咽痛(14.1%)。相对罕见的首发症状为耳鸣(1.1%)、视力下降(1.1%)、嗅觉减退(1.1%)等,无体质量下降者。ENKTCL患者确诊时间为4(10)个月。首发症状为鼻塞与确诊时间呈正相关(r_s=0.228,P=0.004);首发症状为口咽痛、发热与确诊时间呈负相关(rs值分别为-0.203、-0.258,P值分别为0.007、0.001);首发症状为鼻出血、鼻痛、鼻溢、口咽部溃疡、咳嗽、头晕/头痛、盗汗、结节或包块与确诊时间无直线相关关系(P>0.05)。广义多元线性模型结果显示,首发症状为鼻塞与确诊时间有线性回归关系[β=0.355,95%CI(0.022,0.687),χ~2=4.372,P=0.037]。结论鼻塞是ENKTCL患者最常见的首发症状,且有鼻塞症状的ENKTCL患者所需的确诊时间更长。对于有长期鼻塞症状的患者,医生应认真考虑ENKTCL的可能性,需要时应及时进行反复病理活检。

Background The prognosis of patients with early and advanced extranodal nasal NK/T-cell lymphoma（ ENKTCL） is significantly different. However,ENKTCL is usually misdiagnosed as other diseases in clinical practice. Some previous studies suggested that misdiagnosis of ENKTCL might be related to the nonspecific nature of its initial symptoms. Objective To analyze the relationship between initial symptoms of ENKTCL and time of diagnosis,and explore the factors influencing time of ENKTCL diagnosis in order to provide reference for the early diagnosis of ENKTCL. Methods We retrospectively collected the clinical data of patients who diagnosed with ENKTCL and met the inclusion criteria between 2009 and 2012 in West China Hospital,Sichuan University. The relationship between initial symptoms of the patients and time of diagnosis and the influencing factors of diagnosis time were analyzed. Results One hundred and seventy-seven ENKTCL patients were enrolled finally. The median age was 42（ 22） years. Males were in the majority（ accounting for 71. 2%）. The common initial symptom was nasal congestion（ 54. 8%）, followed by nasal rhinorrhea（ 21. 5%）, fever（ 18. 1%） and oropharyngeal pain（ 14. 1%）. Relatively rare initial symptoms were tinnitus（ 1. 1%）,decreased vision（ 1. 1%）,hyposmia（ 1. 1%）,etc. No one presented weight loss. The diagnosis time of ENKTCL patients was 4（ 10） months. When the initial symptom was nasal congestion,it was positively correlated with time of diagnosis（ rs= 0. 228, P = 0. 004）. When the initial symptom was oropharyngeal pain or fever,it was negatively correlated with time of diagnosis（ rs=-0. 203 and -0. 258,respectively; P =0. 007 and 0. 001, respectively）. When the initial symptom was epistaxis, rhinalgia, rhinorrhoea, oropharyngeal ulcer,cough,dizziness/headache,night sweats,nodules or masses,it was no linear correlation with time of diagnosis（ P〈0. 05）.The results of generalized multivariate linear model showed that it had linear regression relation with the time of diagnosis when the initial symptom was nasal congestion [β = 0. 355,95% CI（ 0. 022,0. 687）,χ^2= 4. 372,P = 0. 037 ]. Conclusion Nasal congestion is the most common initial symptom of ENKTCL patients,and the patients with nasal congestion require a longer time of diagnosis. For patients with long-term nasal congestion, the doctor should seriously consider the risk of ENKTCL, and repeated pathological biopsies should be performed in time if necessary.